435202897-5-8-2026-26-AS-MPAA-DTW7CA-20260508213225

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435202897
Report Date: 04/22/2026
Date Signed: 05/08/2026 09:35:03 PM

Document Has Been Signed on 05/08/2026 09:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME:	FAMILY FEELS RESIDENTIAL CARE		FACILITY NUMBER:	435202897
ADMINISTRATOR/ DIRECTOR:	SHIH, YIWEN		FACILITY TYPE:	740
ADDRESS:	781 TERRAZO DR		TELEPHONE:	(408) 300-1757
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY: 6		CENSUS: 4	DATE:	04/22/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:15 PM
MET WITH:	Philipp Perez		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced annual required inspection and met with Administrator (ADM) Philipp Perez and stated the purpose of the visit. The facility is licensed to serve adults age 60 and over and approved for capacity of 6, 5 may be non-ambulatory and 1 ambulatory and approved for 2 hospice waiver. LPA toured the facility, including common areas, resident rooms, kitchen, bathrooms, driveway, and outdoor spaces and storage areas. The kitchen was sanitary and organized; knives and chemicals were locked. Food supply met requirements (2 days perishable, 7 days non-perishable). Bathrooms had grab bars and non-skid mats. Resident rooms had adequate storage for personal belongings. Medications were locked and inaccessible to residents; first aid kit was complete. Outdoor areas were free of hazards; laundry appliances were functional, and cleaning supplies were secured. LPA observed fire, smoke, and carbon monoxide alarm systems were operational; indoor hallways were clear and well-lit. The facility's ramp at the back is sturdy and in good condition. The exit doors are free from tripping hazard and free from obstruction. Indoor temperature was within acceptable range of 65°F. Kitchen water temperature measured at 111.9 up to 112.1°F. 2 out of 2 bathroom hot water temperature was measured and range from 113.1°F to 114.9°F. Refrigerator temperature is at 32°F and freezer temperature is at 0°F. page 1 of 2

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/22/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: FAMILY FEELS RESIDENTIAL CARE	FACILITY NUMBER: 435202897
	VISIT DATE: 04/22/2026

NARRATIVE

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LPA reviewed resident and staff records, including medication logs, admission agreements, care plans, health screenings, and training. All staff have required fingerprint and background clearances and 1st Aid/CPR certifications.

Based on record review that the facility last conducted the fire and earthquake drill April 16, 2025. The facility Emergency Disaster plan last update was done on 08/24/2024. S2s has no dementia training. Based on record review 2 out of 4 residents have dementia and 1 out of 4 has mild cognitive impairment (MCI) and 1 out of 4 is conserved and 1 out of 4 is under hospice care.

Deficiencies were cited during today's visit based on the California Code of Regulations (CCR) Title 22. See LIC 809D. An exit interview was conducted with Administrator Philipp Perez and a copy of the report was provided.

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end of report

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/22/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 05/08/2026 09:35 PM - It Cannot Be Edited

Created By: Maria Partoza On 04/22/2026 at 04:07 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: FAMILY FEELS RESIDENTIAL CARE	FACILITY NUMBER: 435202897
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87705(b)(1)

87705 Care of Persons with Dementia (b) Licensees shall be responsible for the following: (1) Ensuring staff receive the following training as part of the training requirements specified in Section 87208 Plan of Operation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above by not ensuring S2 completed the required direct staff of 12 hours dementia care training devoted to care of persons with dementia. Based on record review 2 out of 4 resident are diagnosed with dementia, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/23/2026
	Plan of Correction
1 2 3 4	ADM stated that he/she will notify licensee and will submit a written plan of correction to address the training requiremnet of S2 by the POC due date of 04/23/2026.

Type A

Section Cited

HSC

1569.695(b)

§1569.695 Emergency Plans (b) A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above by not ensuring that emergency plans are done annually that includes the staff responsibility during an emergency or disaster. Based on record review the facility conducted the emergency plan on 08/05/2024, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/23/2026
	Plan of Correction
1 2 3 4	ADM stated that he/she will notify the licensee and will submit a written plan of correction to address the required emergency plan, and include stasff responsibilities during an emergency or disaster to comply with the Health and Safety Code 1569.695. ADM stated that he/she will submit the plan of correction by the POC due date of 04/23/2026.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:

	Maria Partoza
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/22/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 05/08/2026 09:35 PM - It Cannot Be Edited

Created By: Maria Partoza On 04/22/2026 at 04:35 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: FAMILY FEELS RESIDENTIAL CARE	FACILITY NUMBER: 435202897
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/22/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1569.695(c)

§1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation...it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above by not conducting the drills at least quarterly for each shift, the facility conducted the fire drill on 04/16/2025, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/23/2026
	Plan of Correction
1 2 3 4	ADM stated that he/she will notify the licensee and will submit a written plan of correction to address quarterly drills for each shift and taking into account different emergency scenarios. ADM stated that he/she will submit the written plan of correction by the POC due date of 4/23/2026.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:

	Maria Partoza
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/22/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC809 (FAS) - (06/04)

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